Influenza Vaccine Consent Forms / Formularios de autorización de la vacuna contra la influenza (gripa)
Child Influenza Consent English
Formulario de autorización para niños
Adult Influenza Consent English
Formularios de autorización para adultos
**Please be sure to check the vaccine status of yourself and your child. If you need assistance checking a vaccine status, please call the Menasha Health Department at 920-967-3520.**
Immunizations are one of public health's greatest achievements. Vaccines help prevent diseases and help keep people of all ages healthy. To make sure you are completing the appropriate vaccine schedule on time, please contact your primary care provider.
Vaccine Eligibility Requirements
Children through 18 years of age who:
- have no insurance
- are underinsured (has health insurance but the coverage does not include vaccines)
- are on Medical Assistance (includes BadgerCare)
- are Native American or Native Alaskan.
Children who are insured for vaccines should be seen by their primary care provider for needed immunizations.
To schedule an appointment, please contact the Menasha Health Department at 920-967-3520.
- An individual sick with something more serious than a cold and/or a fever of 100.4 degrees on the day of the clinic should not receive immunizations that day.
- Children under 18 years of age must be accompanied by a parent or guardian. If a parent/guardian is unable to accompany the child, we require written permission from the parent/guardian and another adult to accompany the child.
Check immunization records here
- Immunization Action Coalition
- Northeast Wisconsin Immunization Coalition
- Children's Hospital of Philadelphia
- CDC Vaccines